Rochelle Riley: Detroiters dying before their time

July 1, 2012

Detroit Free Press columnist

People in Detroit age faster and die sooner than their counterparts elsewhere in Michigan, according to a study that draws the tragic conclusion that the city's new "elderly" are as young as 50.

Residents in the study area, which included eight smaller communities, who are 50-59 years old are 60-74 in terms of their health and die at a rate 131% higher than their peers around the state, according to "Dying Before Their Time," a report to be released next week by the Detroit Area Agency on Aging.

The higher mortality rate is driven mainly by Detroit residents who have more chronic illnesses, require more hospitalizations and have less access to health care than people of the same age in the rest of Michigan, the study found.

"Individuals 50 to 59 have an onset of chronic illnesses that you see in people 60 to 74 outstate," said Paul Bridgewater, CEO of the agency. "And they are carrying that burden longer and not getting access to health care. So they're dying at the same rate as those individuals out in the state who are 60 to 74. Preventable hospitalizations in the Detroit study area were 2.4 times greater than in the rest of the state among adults 45 to 64 years old."

The landmark report resulted from a three-year study -- 2007-09 -- of people in the agency's service area of Detroit, Hamtramck, Harper Woods, Highland Park and the Grosse Pointes.

But the frightening numbers are driven by Detroit, where residents are sicker, have less access to health care and cling to dangerous traditions. And at least one city official wasn't surprised.

"It's cultural," said Detroit City Council President Charles Pugh, who has been pushing an agenda of improved health and released a healthy eating video that showed how he lost weight. "We're a largely African-American city, and we fry everything. And we use lots of sugar and lots of salt and lots of sodium. We put hot sauce and butter on everything. We have stupid portions, too large, and that's part of who we are. Soul food is extremely unhealthy."

Pugh said he wants to work with Mayor Dave Bing on a health initiative that could lower the city's $200-million to $300-million annual health care bill for employees -- and be a pilot for citizens.

The report said that the new elderly, those 50-59, "who do survive enter their senior years already sick and weakened from battling years of chronic illness."

"The excess death toll is believed to be the result of delay in seeking care for chronic and other conditions by those who do not have insurance and cannot afford health care," the report said.

The report's release comes as members of Congress take sides over President Barack Obama's national health care reform that was upheld last week by the U.S. Supreme Court and includes a mandate for health insurance, effective in 2014. Republican presidential candidate Mitt Romney said he'll repeal it if elected, but hasn't said what he'll offer instead for uninsured Americans, including 1.1 million in Michigan.

Bridgewater said that the only way his agency can keep up with the new elderly is to greatly increase service.

"It's going to cost us double. ... We've got young elderly with the health challenges and full-blown illnesses that didn't used to happen," he said. "That's why we've seen this premature death rate."

Detroit faces two challenges in helping the new elderly.

First, opening up health insurance to hundreds of thousands of new patients requires enough doctors to see them; but over the last decade there has been a 25% decline in medical students going into primary care, said Dr. Herb Smitherman, assistant dean of Community and Urban Health at Wayne State University School of Medicine and a coauthor of the report.

He explained this is "largely because you come out with a lot of debt -- $150,000- $200,000 or more. It's a house note just to pay for your medical school education and primary care physicians make, on average, around $130,000- $140,000" -- far less than surgeons or other specialists.

"It's one thing to cover 30 million people," Smitherman said. "But you've got to have enough providers and nurse practitioners."

Second, as residents in the agency's study area get sicker at a younger age, the number who need care grows faster than expected.

"Even my wife reports young children now on anti-hypertensive medication and lipid-lowering medication because they're developing diabetes because of obesity," said Smitherman, whose wife, Dr. Lynn Smitherman, is a respected Detroit pediatrician. "Cardiovascular disease that we're used to seeing a decade later, we now see a decade sooner. People are getting sicker younger and younger."

Bridgewater, whose agency is fighting a tide of challenges just to provide services to the traditional elderly, now sees a need to expand his reach.

"That population is getting sick and ill with high hospitalizing now at age 60," he said. "If I would have had the opportunity to intervene early with meals, outreach, home health care, that would have decreased some of those risk factors. ... We're going to have to reach out at an earlier age because if we don't stop these illnesses in these younger age groups, all we're going to be doing is managing a whole bunch of chronic illness."